What are the typical duties of RNs in cardiac nursing?

jezlynh · Aug 21, 2012

I work on a cardiac critical care unit that admits and recovers pts going for various cardiac/IR procedures. I usually have about 6 pts throughout the day unless i am paired with only 2 because they have a swan. I'm basically running around for the entire 12 hr shift. Come in, get report, quickly peak in on my patients and introduce myself if they are awake. Check labs, vitals and for any overdue meds. Coffee. Pulls meds from supply station, make sure all meds are there if not order them from

Pharmacy. Go back into pts rooms, fully assess them let them know what plan for the day is. Check Vitals and accuchecks (sometimes done by tech). Administer morning meds. Deliver breakfast (sometimes done by tech). Do am care like baths, oral care etc. Meet with MD's and residents and report any abnormal findings, address any concerns. If they don't come around by 9 and I need to notify them of something I call them. Then I begin the discharge process which whatever pts are discharged. Go over instructions, make sure they have prescriptions they need etc. then around 11am pts start coming out of their procedures like angiograms/ pacemaker insertions, IR procedures so I am recovering them which involves q15 min vitals and frequent site checks of their incisions. And most of the rest of the day is spent recovering people from various procedures, checking labs, ekg's and giving meds and notifying MD of any abnormalities and calling MDs to give me orders.

jezlynh · Aug 21, 2012

Oh and I forgot that in the midst of all this I am doing a lot of documenting in the computer.

eleectrosaurus · Aug 21, 2012

Thanks Jezlynh, I was wondering about this too. I got hired as a new grad to a simmilar unit. My new manager was explaining the workflow of the day simmilar to yours, lots and lots of admit/discharges and paperwork. He followed up if I want to start on nights or days, i opted for nights, thinking the pace might be a bit better for all the learning i would have to do.

Can you tell us how a night shift typically goes?

Thanks,

chriso3030 · Aug 22, 2012

Hi there, just recently got hired to the cardiac care unit and telemetry floor about 4.5 months ago.

My day starts off by getting report starting around "7" am, I put it in quotes because unfortunately things don't really get started till about 7:20 which is already eating into my morning. Then I check the charts and labs on my usually 6 patients which takes me into 8am, then I go check on my patients and get vitals so I know whether to give meds or not. Then I go get my medication from 3 different accudoses or pyxis or whatever you know it as, seeing as my damn floor is so big, plus get meds out our their individual pharmacy boxes, which puts my 8 am meds being administered right around 9:30. Life sucks on such a busy floor. The only thing worse is when cath lab, ct, x ray, surgery, and dialysis transport is there at 745/8am and I haven't even done squat, now I gotta rush over to get that pt's vitals and somewhat blindly give them their AM mess if I happened to check their charts in time. I sometimes will hold meds until they get back if I feel too rushed. But yeah, that's pretty much at least my mornings until about 11am. Then it's a matter of doing procedures, checking charts, giving more meds, answering calls about the bathroom or food being too cold. Ps, some stuff that you and I know the assistant can do, can only be done by an RN in the patients eyes like getting more water with no ice and some saltines. Anyways, does this schedule sound familiar. Oh, I forgot the late doctors who insist on DC'ing a pt at 530pm when you're just trying to get your documenting in order and hand out your last few meds, and you charge nurse sees that hey, you only have 5 pt's, how about another hour long admission that you can't put off to night shift because it's too early. Sheesh. I love this job :) lol

JoshRN81 · Aug 23, 2012

What happens if you can't get everything done before the end of the day?

KBICU · Aug 23, 2012

Well hopefully you at the BARE minimum your patients got their meds went to their ordered testing (echo, xray, ct, etc) and you did your assessments....if your late doing something and its the end of your shift you have to pass it on ie you didnt get the antibx hung or you didnt clear your pump...most important thing? Your patients stay safe. Also, its important to know your patients so you can recognize when something changes...ie your patient who was breathing normal and in NSR at 0800 is now having increased WOB at 1200 with increasing PVCs...

Beverage · Aug 24, 2012

Cardiac Tele floor: I get assignment and look up labs before start of shift. Take report at bedside on 4 pts then get the 1st set of VS and do my assessments, flush IV's, check IVF, gtt's and chart VS, IV & risk assessments using a WOW at bedside, usually finish around 8am. Cover insulin and then start AM meds, pulling from pyxis and med cart. Finish between 9:30-10 and go eat my breakfast-coffee. I chart Assessments, Education and Care plans after breakfast and chart interventions t/o shift as performed. The rest of the day is highly variable, pt's going off floor for procedures, pacers, CXR, Echo, US, Cath lab, Stress tests, HD. Start IV's (they always go bad when you have a new bag of PRBC's...) Rounding with MD's, updating family at bedside, fetching "stuff" because the CNA is busy in isolation room. Dressing changes, making sure pt get's up to chair for meals and CNA ambulates them. CNA's do baths and most daily care. I may have a CABG with CT's, confused, restraints, multiple Isolation... MRSA, C-diff, shingles, scabies..., Total care turn q2hr, NGT with tube feeding, pain management and multiple IVPB's, Meds t/o the day, 1-2 units PRBC's, Mag & K scales, Accuchecks with Novolog coverage, discharges and new admits or transfers in. Our most common gtts are Amiodarone, Cardizem, Dopamine, Dobutamine, Integrillin, Heparin& Lasix. We only do Insulin gtt's on new CABG patients. I've started the shift (more than once) with patient BP 70's/40's which is usually a RATT call unless the pt is AOx4, asymptomatic, with Cardizem or Amiodarone gtt infusing, Stop gtt, call to MD to inform and get new orders. I usually get lunch around 1430, charge nurse holds my pager and that is my 30 mins to sit.

turnforthenurse, MSN, NP · Aug 27, 2012

I work 7P-7A. I come in, get report, quickly go over the charts to look at labs, any diagnostic tests (results and any future scheduled ones), 12-lead EKG (and I will peak at the monitor to see what their current rate/rhythm is), and medications, then I go introduce myself and do my assessments. I pull my meds and start my med pass. As far as other things, it really depends on the night and the type of patients I have. We have total care patients, we have patients who will be on our unit for weeks vs. most of the patient population that are only there for a few days. It's a high turnover rate of patients so that makes things different. I still do dressing changes, administer blood/blood products, drop in NG tubes, manage tube feedings, administer TPN/lipids, get patients who are confused and in restraints or have sitters, have patients in isolation as well as reverse isolation, bring patients down for tests...etc. We have drips on our floor - Dopamine (we can titrate up to 5mcg/kg/min), Dobutamine (usually being weaned off), Cardizem (can titrate up to 15mg/hr), Lasix, Octreotide (rare), Heparin, Integrillin (though I have never seen this one), Amiodorone and NTG (titrate for chest pain only, not BP). We do not have insulin gtts on my floor except on a very rare occasion. We prepare patients for tests such as stress tests and cardiac caths. We get post-cath patients. Sometimes I have to pull a sheath which I hate because an uncomplicated sheath pull leaves you in the room for AT LEAST 30min and you need to have at least two sheath-certified RNs at the beside...sometimes another RN is busy. I call the MD with changes. I rarely discharge on my shift, but when I do it's usually by 2100-2200. We get admissions - sometimes A LOT! I try to round with the doctor with my admission(s) but sometimes that isn't always possible. I hang a lot of IV antibiotics.

I'm pretty much running up until 2300-0000. I take my lunch between 0030-0200, depends on how busy I am. There are some nights where I won't even have time to take a lunch break, believe it or not...so many people think that all we do is just "sit around" on night shift.